Obstetric Emergencies

Question 1

What are examples of obstetric emergencies?

Answer 1

Shoulder dystocia
Postpartum haemorrhage
Cord prolapse

Question 2

What is Shoulder dystocia?

Answer 2

Foetal shoulder becomes impacted behind maternal pubic symphysis after delivery of the foetal head.

Occurs between extension and restitution.

Foetal O2 can drop.

Question 3

What are the main causes of concern for obstetric emergencies?

Answer 3

• Umbilical cord entrapment
• Brachial plexus damage
• Inability of chest to expand properly
• Severe brain damage or death due to hypoxia/acidosis if delivery is delayed

Question 4

What is the acronym for management of shoulder dystocia?

Answer 4

HELPERR

Question 5

What is the management of shoulder dystocia?

Answer 5

H - call for help
E - episiotomy (evaluate)
L - legs into McRobert's position
P - pressure (suprapubic)
E - Enter manouvers (internal rotation)
R - remove posterior arm
R - roll patient onto all 4s

Question 6

What are the main causes of PPH?

Answer 6

Thrombin
Tissue
Tone 
Trauma 
Other

Question 7

Examples of thrombin causes of PPH?

Answer 7

• Bleeding disorders
• Pre-eclampsia
• Placental abruption
• Pyrexia

Question 8

Examples of tissue causes of PPH?

Answer 8

• Retained placenta
• Placenta accreta (placenta grows too deep into uterine wall)
• Retained products of conception (RPOC)

Question 9

Examples of tone causes of PPH?

Answer 9

• Previous PPH
• Placenta praevia
• Over distension of the uterus eg multiples, polyhydramnios, macrosomia
• Uterine relaxants

Question 10

Examples of trauma causes of PPH?

Answer 10

• C-section
• Episiotomy
• Macrosomia

Question 11

Examples of other causes of PPH?

Answer 11

• Age
• BMI>35
• Asian ethnicity
• Anaemia
• Induction
• Prolonged labour

Question 12

What is primary PPH?

Answer 12

• First 24 hours after birth
• > 500ml blood
• Severe >2000ml

Question 13

What is secondary PPH?

Answer 13

• > 24 hours – 6 weeks PP

* Often caused by RPOC

Question 14

What is the management of PPH?

Answer 14

• ABCDE
• Empty bladder
• Rub uterine fundus
• Medications
• Surgical intervention

Question 15

What is the medical management of PPH?

Answer 15

• Oxytocin IV/injection
• Ergometrine
• Tranexamic acid
• Carboprost
• Misoprostol

Question 16

What is the surgical management of PPH?

Answer 16

• Intrauterine balloon tamponade
• B-Lynch suture
• Hysterectomy
• Manage on clinical signs, not just estimated blood loss (EBL)
• Fluid replacement +/- blood products

Question 17

What is Cord prolapse?

Answer 17

Descent of umbilical cord through the cervix alongside (occult) or past (overt) the presenting part in the presence of a ruptured membrane.

Question 18

What are the risk factors for cord prolapse?

Answer 18

• Arrangement of things in the womb: Polyhydramnios, Low-lying placenta
• Presentation of: Breech presentation, transverse/oblique/unstable lie
• More than one coming out: Multiparity, 2nd twin
• Room for the cord to fall out: Preterm labour, Low birthweight, Unengaged presenting part, Fetal congenital abnormalities

Question 19

What is the management for cord prolapse?

Answer 19

• Call for help
• Replace cord into vagina (reduce chances of compression, vessels spasming due to cold temperature)
• Digital elevation of the presenting part
• Catheterise and fill bladder to elevate presenting part
• Encourage mother the adopt knee-chest or left lateral position with raised hips
• Consider tocolysis (suppress labour)
• Arrange a Cat 1 C section